Policy briefs

At a July 8 meeting of ACP-ASIM's Council of Subspecialty Societies, officials said that they wanted feedback from physicians on how to fine-tune evaluation and management (E/M) guidelines.

"We're sympathetic to doctors' concerns that documentation takes time away from caring for patients," Robert A. Berenson, FACP, director of HCFA's Center for Health Plans and Providers, told the group. "But the profession needs guidelines. There's no way around that."

Dr. Berenson said that the agency needs help in making sure that any new documentation guidelines are balanced. If they are imprecise, he pointed out, they are open to abuse. He added, however, that if guidelines are too precise, physicians may place administrative concerns above patient care.

As of July 1, HCFA has expanded its coverage of services for beneficiaries with diabetes and established criteria for reimbursing for bone mass measurement procedures. These changes, required by the Balanced Budget Act of 1997, follow HCFA's expansion this year of its preventive service package to cover certain colorectal cancer screening services, such as flexible sigmoidoscopies and colonoscopies.

HCFA made the following changes:

Medicare now pays for diabetes outpatient self-management training in a variety of nonhospital, outpatient settings. Previously, HCFA covered only hospital-based outpatient programs. Services must be furnished by a certified provider.

Medicare has also expanded its coverage of blood glucose monitors, test strips and lancets to diabetics who are not being treated with insulin. Previously, HCFA covered these devices only for patients being treated with insulin.

Medicare issued regulations on coverage for some newer, FDA-approved methods of measuring bone mass, detecting bone loss or interpreting bone quality. Coverage applies to patients who are at risk for—or are taking medications for—osteoporosis, have bone abnormalities, are on steroid therapy or have primary hyperparathyroidism.

ACP-ASIM is concerned that HCFA may postpone physician payment updates in reaction to worries about the year 2000 (Y2K) problem.

An internal HCFA memo leaked to the public suggested that the agency may ask Congress to postpone physician payment updates scheduled for the year 2000 so it can devote more resources to the Y2K problem. The memo suggested that HCFA would also use the delay to comply with provisions of the Balanced Budget Act of 1997.

HCFA processes an estimated one billion transactions a year, and its computer vendors must fix approximately 42 million lines of computer code to address Y2K problems.

ACP-ASIM has argued that postponing payment updates would not only delay regularly scheduled updates but also the beginning of the second year of transition to resource-based practice expenses, which would hurt many internists.

ACP-ASIM is trying to determine exactly what updates and payment changes would be delayed, and how physicians would be reimbursed for losses resulting from those changes.

"The issue is more than one about dollars," College President Harold C. Sox said in a statement. "It involves questions of whether or not physicians and beneficiaries can be confident that the Medicare program will be able to-and will-meet its obligations to them in the year 2000 and beyond."

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